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BSN: 4th Quarter > MH EXAM #3 > Flashcards

MH EXAM #3 Flashcards

1
Q
  1. Which of the following should RN include in plan of care for bipolar client?
A

—Establish consistent limits
— Offer concise explanations
— Use firm approach communication

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2
Q
  1. The RN recognizes repetitive behavior in OCD is for which of the following reasons?
    A. Narcissistic behavior
    B. Fear of rejection from staff
    C. Attempt to reduce anxiety
    D. Adverse affects of antidepressant meds
A

C. Attempt to reduce anxiety

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3
Q
  1. Which of the following actions should the RN take w/ a client experiencing a panic d/o?
A

Stay with the client and remain quiet (patient is NOT going to hear you when they’re panicking)

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4
Q
  1. Which of the following indicates understanding by a new RN of ECT of bipolar d/o?
A

ECT is effective for clients experiencing mania (SEVERE)

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5
Q
  1. Which indicates an understanding by a new RN caring for a client w/ a personality d/o?
A

I should practice limit-setting to help prevent client manipulation

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6
Q
  1. Which is expected from a client who has avoidant personality d/o?
A

I’m scared you’re going to leave me

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7
Q
  1. Which of the following should the RN ID as a RF for depression?
A

male sex; hx of chronic bronchitis; recent death in client’s family; family hx of depression; personal hx of panic d/o; NONE of these; its FEMALE who’s affectd most

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8
Q
  1. RN actions is a priority w/ a MDD and anxiety d/or client?
A

Placing a client on 1-to-1 observation (higher risk of suicide)

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9
Q

Delirium vs. Dementia vs. Alzheimer’s

A

Delirium — mental state characterized by an acute disturbance of cognition (short-term confusion, excitement, disorientation, clouding of consciousness; hallucinations + illusions = common)
Dementia —

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10
Q

S/Sx of Delirium

A

Difficulty sustaining and shifting attention
Extreme distractibility
Disorganized thinking
Speech that is rambling, irrelevant, pressured, and incoherent
Impaired reasoning ability and goal-directed behavior
Disorientation to time and place
Emotional instability
Disturbances in sleep-wake cycle

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11
Q

Autonomic manifestations of Delirium

A

Tachycardia
Sweating
Flushed face
Dilated pupils
Elevated blood pressure

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12
Q

RF of delirium

A

Infections, febrile illness, metabolic disorders, head trauma, seizures, migraine headaches, brain abscess, stroke, electrolyte imbalance, and others

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13
Q

What is a neurocognitive disorder?

A

Impairment in the cognitive functions of thinking, reasoning, memory, learning, and speaking
Mild NCD = mild cognitive impairment
Major NCD = used to be known as dementia

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14
Q

Results of temporary dementia

A

Stroke
Depression
Side effects of medications
Nutritional deficiencies
Metabolic disorders

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15
Q

—Stages of Alzheimer’s disease (AD)

A

Stage 1: No apparent symptoms
Stage 2: Very mild change
Stage 3: Mild cognitive decline
Stage 4: Moderate cognitive decline — forget major events, personal hx (e.g. own child’s birthday, can’t shop, cook, manage personal finances)
Stage 5: Moderately severe cognitive decline — unable to do some ADL’s (hygiene, dressing, grooming); depression & social w/drawls = common
Stage 6: Severe cognitive decline — sundowning; institutional care required
Stage 7: Very severe cognitive decline — Belfast & aphasic

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16
Q

Hospitalized and diagnosed in the fourth stage of N C D due to A D, a patient, when asked about the previous evening, describes a wonderful evening spent on a cruise. Which symptom is the patient exhibiting?
A. Aphasia
B. Confabulation
C. Delirium
D. Apraxia

A

Confabulation
RATIONALE: Confabulation is a behavioral reaction to memory loss in which the patient fills in memory gaps with information about events that have not occurred. During the 4th stage of Alzheimer’s dementia, a patient will use confabulation in an effort to maintain self-esteem.

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17
Q

RF of AD

A

Neurotransmitter alterations
Plaques and tangles
Head trauma
Genetic factors

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18
Q

A patient is newly diagnosed with secondstage N C D due to A D. Which cognitive change would a nurse observe?
A. Memory disturbance
B. Confabulation
C. Apraxia
D. Inability to plan or organize

A

A. Memory disturbances
RATIONALE: In the second stage of the illness, losses in short-term memory are common and the individual may begin to lose things or forget names of people. It’s at this stage that a diagnosis may be considered.

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19
Q

S/Sx of dementia pugilistica?

A

related to repeated — head trauma

Emotional lability
Dysarthria
Ataxia
Impulsivity

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20
Q

Which statement is true about vascular dementia?

A. Vascular dementia is reversible.
B. Vascular dementia is characterized by plaques and tangles in the brain.
C. Vascular dementia involves a gradual, progressive cognitive deterioration.
D. Vascular dementia involves a variable pattern of cognitive functioning.

A

D. Vascular dementia involves a variable pattern of cognitive functioning.
RATIONALE: In vascular dementia, patients suffer the equivalent of small strokes that destroy many areas of the brain. The pattern of deficits is variable, depending on which regions of the brain have been affected.

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21
Q

Physical assessment of neurological examination r/t neurocognitive disorders

A

— 1) signs of damage to the nervous system and (2) evidence of diseases of other organs that could affect mental function.

— Neurological examination to assess mental status, alertness, muscle strength, reflexes, sensory perception, language skills, and coordination

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22
Q

Tx for Delirium

A

Determination and correction of the underlying causes
Staff to remain with patient at all times to monitor behavior and provide reorientation and assurance.
Room with low stimulus level
Low-dose antipsychotic agents to relieve agitation and aggression
Benzodiazepines commonly used when etiology is substance withdrawal

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23
Q

Tx for Neurocognitive disorders (NCD)

A

Primary consideration is given to etiology, with focus on identification and resolution of potentially reversible processes.
Pharmaceutical agents for cognitive impairment
Physostigmine (Antilirium)
Donepezil (Aricept)
Rivastigmine (Exelon)
Galantamine (Razadyne)
Memantine (Namenda)
Pharmaceutical agents for agitation, aggression, hallucinations, thought disturbances, and wandering
Risperidone (Risperdal)
Olanzapine (Zyprexa)
Quetiapine (Seroquel)
Ziprasidone (Geodon)

24
Q

A patient has recently been diagnosed with mild to moderate N C D due to A D. Which medication would the nurse expect the physician to order for this patient’s cognitive impairment?
A. Nortriptyline (Pamelor)
B. Zaleplon (Sonata)
C. Donepezil (Aricept)
D. Quetiapine (Seroquel)

A

C. Donepezil (Aricept)
RATIONALE: Donepezil is used to improve cognition in patients diagnosed with mild to moderate dementia associated with Alzheimer’s disease. Its action improves cholinergic function by inhibiting acetlycholinesterase.

25
Q

Meds for depression

A

Pharmaceutical agents for depression
Selective serotonin reuptake inhibitors
Often considered first-line due to favorable side-effect profile
Tricyclic antidepressants
Often avoided due to anticholinergic and cardiac side effects
Trazodone (Desyrel)
Good choice for patients with insomnia
Dopaminergic agents
Helpful in treatment of severe apathy

26
Q

Pharm methods for anxiety

A

Chlordiazepoxide (Librium)
Alprazolam (Xanax)
Lorazepam (Ativan)
Oxazepam (Serax)
Diazepam (Valium)

27
Q

Pharm Tx for sleep disturbances (insomnia)

A

Pharmaceutical agents for sleep disturbances (for short-term therapy only)
Flurazepam (Dalmane)
Temazepam (Restoril)
Triazolam (Halcion)
Zolpidem (Ambien)
Zaleplon (Sonata)
Ramelteon (Rozerem)
Eszopiclone (Lunesta)
Trazodone (Desyrel)
Mirtazapine (Remeron)

28
Q

Subjective assessment for Mood disorders

A

anergia, anhedonia (lack of life pleasures), anxiety, feeling sluggish(most common), or feeling unable to relax and sit still, vegetative findings such as in eating patterns (anorexia in MDD, increase intake in dysthymia and PMDD), change in bowel habits(usually constipation), sleep problems and decreased interest in sex.

29
Q

Objective assessment for mood disorders

A

affect- most often looks sad with blunted affect.
Poor grooming and hygiene. Psychomotor retardation(slowed physical movement, slumped posture) is more common, but psychomotor agitation (restlessness, pacing, finger taping) can also occur.
Socially isolated, showing little or no interest. Slowed speech, decreased verbalization, delayed response, may appear too tired to speak.

30
Q

RF of mood disorders

A

Neurotransmitter deficiencies, such as serotonin deficiency( affects mood, sexual behavior, sleep cycles, hunger, and pain) or norepinephrine deficiency (affects attention and behavior). Family history, age since depressive disorders more common in females between 15 and 40 years of age, elderly over 65, stressful life events, medical illness, postpartum, poor social interaction, comorbid substance use, being unmarried.

31
Q

Tools to detect mood disorders

A

Hamilton Depression Scale
Beck Depression Inventory
Geriatric Depression Scale (short form)
Zung Self-Rating Depression Scale
A confidential screening tool can be found at www.depression-screening.org

32
Q

RN Interventions for mood disorders

A

Milieu Therapy
Suicide risk
Self-care
Communication
Maintenance of a safe environment
Counseling — assist with problem solving, increasing coping skills, changing negative thoughts to positive ones, increasing self-esteem, assertiveness training, using community resources.
Medications

33
Q

Pharmacotherapy for Mood disorders

A

Selective Serotonin Reuptake Inhibitors (SSRIs)
Tricyclic Antidepressants
Monoamine Oxidase Inhibitors (MAOIs)
Atypical Antidepressants
Serotonin Norepinephrine Reuptake Inhibitors

34
Q

Patient teaching for patient w/ mood disorders

A

Antidepressants
Do not discontinue medication suddenly
Therapeutic effects are not immediate, and it may take several weeks or more
Avoid hazardous activities due to potential adverse effect of sedation
Notify the provider of any thoughts of suicide
Avoid alcohol while taking an antidepressant

35
Q

Collaboration for patients w/ mood disorders

A

Psychotherapy by a trained therapist may include cognitive behavioral therapy (CBT), interpersonal therapy(IPT), group and family therapy.
Alternative or Complimentary Therapies: St. John’s wort and Light therapy
Therapeutic Procedures:
Electroconvulsive therapy (ECT)- must be trained nurse to monitor the client before and after treatment.
Transcranial magnetic stimulation (TMS)
Vagus nerve stimulation

36
Q

Which mood disorder can mimic ADHD?

A

Biplolar disorder

37
Q

Bipolar care

A

Care will mirror the phase of the disease that the client is experiencing
Acute- Acute mania. May need to be in the hospital. Reduction of mania and client safety are the goals of treatment. Risk of harm to self or others is determined. One to one supervision may be needed.
Continuation- Remission of clinical manifestations. Treatment is generally 4 to 9 months in duration. Relapse prevention through education, medication adherence, and psychotherapy is the goal of treatment.
Maintenance- Increased ability to function. Treatment generally continues throughout the client’s lifetime. Prevention of future manic episodes is the goal of treatment.

38
Q

Bipolar behaviors

A

Mania—
An a abnormally elevated mood, which may also be described as expansive or irritable; usually requires hospitalization
Hypomania — A less severe episode of mania that last at least 4 days accompanied by 3 to 4 findings of mania. Hospitalization is not required, and the client who has hypomania is less impaired
Mixed episode — A manic episode and an episode of major depression experienced by the client simultaneously. The client has marked impairment in functioning and may require admission to an acute care mental health facility to prevent self-harm or other-directed violence.
Rapid cycling — Four or more episodes of acute mania within 1 year.

39
Q

Difference b/w bipolar I vs Bipolar II

A

Bipolar I — client has at least 1 episode of mania alternating with major depression
Bipolar II — the client has 1 or more hypomanic episodes alternating with major depressive episodes.

40
Q

Purpose of The Mood Disorders Questionnaire

A

Can differ hypomania to acute mania to delirium

41
Q

Manic characteristics

A

Labile mood with euphoria, agitation and irritability, restlessness, dislike of interference and intolerance of criticism, grandiose view of self and abilities, impulsivity ( spends money, gives away possessions), flight of ideas( rapid, continuous speck with sudden and frequent topic change), demanding and manipulative, poor judgement, attention seeking behavior( flashy dress and make-up, inappropriate behavior) See page 110 ATI.
Depressive- flat, blunted, labile affect, tearful, crying, lack of energy, anhedonia(lack of pleasure), difficulty focusing, self-destructive behavior, poor hygiene, loss of appetite/and or sleep. Psychomotor retardation or agitation

42
Q

Therapeutic milieu within an acute setting

A

Provide safe environment, assess for suicide, and escalating behaviors. Decrease stimulation without isolation. Be aware of noise, music, television, and other clients, all which can lead to an escalation of the client’s behavior. Sometimes seclusion is needed to decrease stimulation. Provide frequent rest, outlets for physical activity, follow agency protocols for providing safety, maintenance of self-care needs, and effective communication.

43
Q

Complications for patients who are bipolar

A

Physical exhaustion and possible death
A client in a true manic state usually will not stop moving, and does not eat, drink, or sleep.
Nursing Actions include:
Prevent self-harm
Decrease client’s physical activity
Ensure adequate food and fluid intake.
Promote adequate sleep each night
Assist with self-care needs
Manage medication appropriately

44
Q

Anxiety with ________ leads to anxiety disorder

A

Fear

45
Q

Levels of anxiety

A

Mild
Moderate
Severe
Panic

46
Q

What are the anxiety disorders recognized and defined by the DSM-5?

A

Separation anxiety
Panic disorder
Phobias
Generalized anxiety disorder (GAD)

47
Q

Warning signs of OCD

A

Intrusive thoughts
Compulsive behavior
Becoming isolated
Seeking reassurance
Depression

48
Q

Obsession vs. Compulsion definitions

A

Obsession:
An intrusive, repetitive though or image that produces anxiety
_____________
Compulsion:
The need to perform acts or mental tasks to reduce anxiety

49
Q

Multiparty Model of OCD

A

Biological Dimension
Increased activity in the orbitofrontal cortex
Lower activation in the caudate nuclei
Subgroups differ on genetics and biological involvement
Reduced availability of serotonin and glutamate

Psychological Dimension
* Lack of trust in own performance
* Impulse control conflicts * Anxiety reduction * Cognitive distortions

Social Dimension
Social vulnerabilities: divorce, separation, unemployment
* Controlling or critical parenting
Sociocultural Dimension
Equally common in males and females
* Onset in childhood is more common in boys
* Cultural differences in obsessions/compulsions

50
Q

Tx for OCD

A
51
Q

PTSD

A
52
Q

Co-Occuring S/Sx between PTS and TBI

A
53
Q

Criteria for PTSD according to DSM-5

A
54
Q

Tx for PTSD other than Medication

A
55
Q

If a patient is experiencing adverse effects of Chlorpromazine, what medication is given and why?

A

Benztropine (Cogentin), an anticholinergic agent, is used to relieve acute dystonia, an extrapyramidal symptom.

56
Q

A nurse is planning care for a client who has made repeated physical threats towards others on the unit. Although the client does not want to leave the unit, the nurse request the provider to transfer the client to a unit that is equipped to manage violent behavior. Which of the following ethical principles to the nurse supply in the situation
A. Nonmaleficence
B. Veracity
C. Justice
D. Autonomy

A

A. Nonmaleficence
RATIONALE: It is the responsibility of the nurse to do no harm to clients. The nurse is applying the ethical principle of nonmaleficence by requesting to transfer this client to a unit better able to manage their behavior and thereby prevent injury to others on the unit.
B. Veracity = being truthful with client & others
C. Justice = treating all individuals equally & fairly
D. Autonomy = respecting client’s rights to make independent choices

BSN: 4th Quarter (10 decks)

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